Resolved,
	Contingencies Fund 2004–05: Accounts of the Contingencies Fund, 2004–05 showing:—
	(1) a balance sheet,
	(2) a cashflow statement; and
	(3) notes to the account; together with the Report of the Comptroller and Auditor General thereon.—[Tom Watson.]

Gordon Brown: As my hon. Friend may know, the British Government and other European countries in particular are signing agreements with a number of countries to give long-term support to those Governments so that they can make allocations to health and education, not just on an annual basis, but on a sustainable basis. We believe that that is the best way of ensuring that money goes to health and education, rather than going to corrupt projects or being wasted. As regards the short term, I will take up my hon. Friend's question about Kenya with my hon. Friend the Minister for overseas development and write to her on the matter.

Dennis Skinner: Is my right hon. Friend aware that, in the 1970s and a lot of the 1980s, we would have thanked our lucky stars in the coalfield areas for growth of 1.75 per cent.? The only thing growing then were the lines of coke in front of boy George and the rest of them.

Barbara Keeley: There is great concern about attacks on firefighters; indeed, there have been 185 incidents against fire crews in Greater Manchester so far this year, and it is unfortunate that a high proportion of those have been in Salford. Following this, the Greater Manchester Fire and Rescue Service, the Chief Fire Officers Association and the Manchester Evening News have got together and are campaigning with Greater Manchester MPs to bring our legislation into line with that in Scotland. In the light of that, does my right hon. Friend agree that we should have a debate on the safety of fire crews, and will the Government consider supporting the private Member's Bill introduced by my right hon. Friend the Member for Swansea, West (Mr. Williams)?

Grant Shapps: Earlier this year, the Prime Minister told Parliament that special advisers should be made to attend Select Committees on exactly the same basis as civil servants, yet last month he blocked his own special adviser, Lord Birt, from attending the Select Committee on Public Administration. May we have an urgent debate on the matter? To many of us, that seems like a case of the Prime Minister saying one thing in public, and doing something completely different in private, when it comes to his own business.

Geoff Hoon: I am sorry that the hon. Gentleman was not present two weeks ago, when this matter was raised, as he would have heard my comprehensive answer. Perhaps he could spend his time over the Christmas recess profitably by studying the Osmotherly rules, which set out very precisely the circumstances in which Ministers may give permission for civil servants, special advisers and others to represent them before Select Committees. Those rules have been in place for a long time, and the point is that they have not changed.

Stephen Hammond: Earlier this year the south-west London health authority concluded its consultation, "Better Healthcare Closer to Home". It concluded that Merton and Sutton needed six local care centres and one acute hospital. However, there was some disagreement about that and the hon. Member for Mitcham and Morden (Siobhain McDonagh) objected and referred the consultation to the Secretary of State for Health. She did so in late June. The subsequent delay is harming my constituents' prospects of getting better health care at the Nelson hospital. Will the Leader of the House ask the Secretary of State to make a statement on the delay, give reasons for it and give a date when we might receive the result of her deliberations and the rationale behind them?

Fraser Kemp: In this new era of bipartisanship will the Leader of the House join me and the Conservative Opposition in endorsing the views expressed by the hon. Member for Epsom and Ewell (Chris Grayling) on 15 November? He outlined the view that Opposition Front Benchers should divest themselves of any outside interests that conflict with their position. Will my right hon. Friend endorse that view, especially bearing in mind the concerns expressed by the Committee on Standards in Public Life?

Geoff Hoon: My hon. Friend makes an interesting suggestion and the issue will certainly be a test of bipartisanship. The hon. Member for Epsom and Ewell has recently talked regularly of observing not only the spirit but the letter of the ministerial code, but does he believe that the spirit of the ministerial code should also apply to Opposition Front Benchers? If he wishes to encourage Ministers to observe the spirit of the code, it should apply equally to Opposition Front Benchers.

Greg Hands: Will the Leader of the House urgently investigate, or allow a debate on, the guidance and procedures for ministerial travel? The reason for that is that I have twice asked the Prime Minister when he last travelled on the London underground; like me, the Leader of the House will be aware that the matter is of great public interest. In the 1997 code, item e, "Public Accountability", states:
	"Individual Ministers are responsible for justifying their actions and decisions to Parliament"—
	on the use of transport. It continued:
	"They will wish to be satisfied that their arrangements could be defended in public."
	It is most interesting that that was written by the Prime Minister, so when will he come to the House to answer my written and oral questions about when he last used the tube? That is a matter of great public interest.

Liam Fox: I thank the Secretary of State for his statement. We welcome the results of the inquiry and its thorough nature. We will study its conclusions in great detail. On behalf of the Opposition, may I again send our sympathy and condolences to the family and friends of those who were killed in this tragic incident?
	It is true that such tragedies are unavoidable in warfare, so we pay tribute to the bravery and professionalism of all our armed forces involved in the Iraq conflict. It is worth reiterating and remembering why they are there, and why they are making those sacrifices. They are doing so to help the people of Iraq achieve freedom, escape tyranny, develop the rule of law and live in a country that respects human rights. Those are noble ideals to fight or die for.
	I agree that it is not appropriate for the House to ask detailed operational questions that could compromise the safety of our troops, but the families of the crew, Hercules passengers and the British public more widely will have concerns with which the Secretary of State may wish to deal.
	There are four specific areas of concern. How many similar incidents were identified before this particular one involving British or American forces in Iraq or Afghanistan, and what changes were implemented as a result? On alterations to aircraft, the Secretary of State said that the fitting of a fuel tank inerting system was being looked at as a matter of urgency. What timescale does that involve? I entirely understand and agree that it would be inappropriate—in fact, dangerous—to speculate on the type of weaponry involved but, without giving details that might compromise the safety of our forces, can he tell us how widespread is the availability of such weaponry and what is its origin?
	Finally, the Secretary of State said that the flow of intelligence information on ground-to-air fire was not as robust as it could be. Does that mean that, on that occasion, intelligence about the specific threat in the area was available but not passed to the flight crew? That would indeed be a tragedy. Fatalities are inevitable in armed conflict, but the House looks to the Government to minimise the risk to our brave and professional armed forces.

John Reid: I thank the hon. Gentleman for his comments, and congratulate him on his new post. This is not the first time that we have shared views across the Dispatch Box, but I know of his commitment to his country and I am sure that that will be reflected in his commitment to the armed forces. I only regret that his first appearance at the Dispatch Box is marked by such a sombre subject. I thank him for the way in which he phrased his questions and for his recognition that we cannot be as open about everything as we are required to be on other subjects. I thank him, too, for the tributes that he paid to the armed forces and for his reminder of the purpose that brings us to Iraq, Afghanistan and other areas, as well as the high ideals that motivate that purpose.
	The hon. Gentleman asked several legitimate and important questions, including how many similar incidents had taken place. Ground-to-air fire incidents are quite frequent. In the previous 18 months or so in Iraq, there were over 800 such incidents, none of which resulted in a tragedy of these proportions. In a sense, therefore, there was an element of chance or bad luck on this occasion. That casts light on other questions, such as why an inerting system was not fitted to the C-130K. Until relatively recently, the Hercules was not routinely deployed to areas of such danger. It has been used on specific occasions, but it has not been routinely deployed as a transport plane, although that has become more frequent after 11 September and the events in Afghanistan and Iraq. There have been a wide range of incidents in which Hercules and other planes have been fired on, but never with this result until now. That is one of the reasons that we carry out such investigations. I will comment on two local incidents in the context of the hon. Gentleman's important last question.
	On the time scale for reviewing whether we should have a new system that would have assisted, that will be done as urgently as is possible. I discussed matters this morning with the Chief of the Air Staff and I know that some recommendations about the tactics have already been put in place and that urgent consideration will be given to whether measures should be fitted to the wings and fuel tanks to suppress the possibility of such an incident happening again.
	The RAF goes to great lengths to fit defensive suites of arrangements. The C-130K is the older version of the Hercules, but I can tell the hon. Gentleman that it has been updated already with such defensive suites as directional infrared counter-measures, missile approach warning systems, radar warning receivers, counter-measures dispensing systems, flight deck armour and a series of other modifications. I would not want anyone to believe that sufficient attention was not paid to these matters. A considerable range of defensive suites have been added, but this is the first example of such an incident happening. The RAF will therefore consider the matter urgently.
	The hon. Gentleman asked whether I could give any indication of the ground-to-air weaponry, without being specific. The indications are that a range of weaponry may have been used against the aircraft. That is precisely why I do not want to be specific about which one might have caused the explosion. Given that a range of weaponry was apparently used, the answer to his question about how widely available such weapons are in Iraq is that they are pretty widely available—the types of weapon that were used, though not necessarily the type of weapon, which I do not want to indicate, that may perchance have been successful.
	The hon. Gentleman asked about the flow of information. What appears to have happened is that there were two attacks in roughly the same area that day against United States helicopters. They occurred within 1 km and 3 km of where the attack on the Hercules took place. This information, which was collated within about three hours of the flight, so there was not a great deal of time in any case to pass such information to the pilots and crew of the Hercules, nevertheless did not reach them because the route of the Hercules was not known to the Americans. There was a compartmentalisation of information as regards the Hercules precisely for security reasons. On a need-to-know basis, there was no need for the multinational forces outside our own preparations for the deployment of the Hercules to know of that.
	That was done for security reasons. With the benefit of hindsight, it would have been better in terms of risk had that compartmentalisation not taken place on that occasion. However, the House should understand why it was done at the time. Even if the information had been available to the crew and pilots before they took off, it may not have changed their decision to proceed. It may or may not have affected the route that they took, but in any case the balance of risk involved was such that, in general terms, the fewer people who know about a particular route, the smaller the risk is considered to be.
	It is obvious that the compartmentalisation meant to reduce the risk involves a risk. That is why one of the recommendations has already been acted upon. We have inserted extra British armed forces personnel into the flow of information in order to try to ensure that, in future, while any such information is compartmentalised to the British, there will be a structure to convey it in circumstances similar to those in question.
	Finally, the hon. Gentleman referred to the tactic of low flying. As I said in my statement, that is being reviewed. Daylight low flying is not being prohibited, because there is a balance of risk. On a short journey, if the normal trajectory rising to a given height and then coming down constitutes almost all the activity, the exposure to certain types of ground-to-air fire becomes greater and far riskier than if the aircraft were flying at a low level, which is why on that occasion that method of travel—low level covering flat ground—was chosen. Nevertheless, that can open up another risk, as we have seen. It re-emphasises the singular point that in an operational theatre such as Iraq, there is no risk-free flying, which is a testimony to the courage of our soldiers.

John Reid: The hon. Gentleman's remarks to the families will be much appreciated, as will his recognition of the dangers of flying, which he has experienced personally. Some of us have had the privilege of flying with the RAF in what is for them a day-to-day, risk- filled theatre, such as Basra or Baghdad. Those of us who have put on body armour, put out the lights and flown at night at an angle of descent that is calculated to terrify most people outside the RAF while swerving understand the risks inherent in such operations. We often forget that such flights are daily occurrences. That particular crew had already flown perhaps four times between Balad and Baghdad before the tragic incident occurred, and they had flown day-in, day-out since their deployment two or three weeks before the incident. Most of the crew were very experienced: between them, they had 19 operational deployments, so they were people who got on with the job as a matter of course and took those risks.
	The hon. Gentleman asked why a fire suppressant system was not fitted to the C-130 and what the position is on the other aircraft. As he knows, the K variant was first developed and built in the 1960s, when that technology was not available. Systems to upgrade the aircraft are now available and we are examining as a matter of urgency whether the technology can be successfully fitted to our aircraft. I must repeat my earlier point that, before the incident, the C-130 Hercules was not thought to be particularly vulnerable to that form of attack. We now know that it in certain circumstances it can be very vulnerable.
	We shall examine this as a matter of urgency. I merely point out that it is not always an easy thing to do. A data recorder, for instance, can be fitted relatively easily into a modern digitised cockpit, but the C-130K was built in the 1960s. Although we can put in a lot of defensive aids, it is not that easy to put in a data recorder where there are multi-faceted, sometimes clockwork, indicators and no central terminal from which to draw the information. There may be difficulties, but we are considering it as a matter of urgency.

Philip Hollobone: I should like to join in with the tributes paid to those tragically killed in this incident. I am sure that the whole House appreciates the manner in which the Secretary of State has delivered this difficult statement. As a humble former paratrooper, I have every reason to appreciate the flying skills of all our Hercules aircrew, especially as most of them are at RAF Lyneham.
	My question concerns the search and rescue capability of our forces in theatre. I note from the statement that the last radio message was at 13.30 and that the crash site was not discovered until 45 minutes later. Is it the procedure that search and rescue missions are launched before aircraft are formally reported missing; and do British armed forces have their own independent search and rescue capability in theatre?

Kevin Barron: First, I declare an interest in that I am currently a lay member of the General Medical Council and it is mentioned with other regulatory bodies and related associate bodies once in the report. I should put that on record. This is my maiden speech as Chair of the Health Committee and the attendance resembles that for my maiden speech in 1983.
	The Committee's report on the influence of the pharmaceutical industry raised questions about how it is regulated and how it regulates itself. As hon. Members know, the pharmaceutical industry is the third most important United Kingdom industry economically after tourism and finance. The report acknowledged its valuable contribution to patient health and the economy. Although I shall mention some problems and some hon. Members might view the industry negatively, I shall put the debate in context by reminding hon. Members of the Health Committee's first conclusion in its report. Paragraph 336 states:
	"The UK-based pharmaceutical industry is large, profitable and highly competitive; it has understandably been described as 'world class and a jewel in the crown of the UK economy'. The industry has an outstanding record in developing new medicines, and is a major source of funding of medical research. The industry's products include many life-saving and important drugs which greatly benefit many people and contribute substantially to national health."
	That is absolutely right. Although I am about to say, "however", that paragraph places the industry in the context in which we should all view it: its contribution to the nation.
	However, the Committee had several concerns about medical research, the conduct of clinical trials, medicines marketing, the information provided to patients and prescribers and the independence of the regulatory system. Overriding themes of the report included the lack of transparency in medicines research and regulation, and the potential effect of that on patient safety.

Kevin Barron: Vioxx is an issue for everyone here, and the Health Committee asked for a public inquiry into the matter, saying that, when a drug is withdrawn in the way that Vioxx was, there should be a public inquiry. The Government did not agree, and I have to say that I have some sympathy with the Government on that. However, the public should have more information on the way in which the drug was licensed and came into use, so that they can be satisfied that we understand the issues surrounding it. My hon. Friend mentioned half a dozen cases. He will be aware that there is the potential for litigation on this matter either in this country or the United States. Reports in The Lancet have put the number of cases in this country of people who have been affected long-term in relation to taking Vioxx at far higher than half a dozen. Perhaps my hon. Friend the Minister will comment on this when he speaks later in the debate.
	The lack of transparency in the MHRA and the industry means that health care professionals do not always have all the information that they need to make appropriate prescribing decisions. The report welcomed the introduction of a register for clinical trials, which will allow professionals and the general public to access information about the development of drugs. The Committee's proposal for maintenance of the register by an entirely independent body was rejected, as was the recommendation that information regarding clinical trials be available at drug launch, so that prescribers could access information during the period when the promotion of a new medicine was at its most concentrated. The Government believe that the publication of such trials within one year of launch is appropriate.
	The Government's response reiterates the importance of a close relationship between the Government and the pharmaceutical industry, citing as a reason the need to ensure transparency in the way in which medicines are brought to the public. The response stresses the role of the ministerial industry strategy group—the MISG—in this respect. Importantly, the response agrees that
	"there is a need to look at whether there is a safer way of introducing new drugs",
	and this is one of the aspects that will be considered by the MISG. I hope that, in doing so, it will consider the issues around Vioxx that my hon. Friend mentioned.
	Corrective statements will not be issued in every case of a breach of legislation, as was recommended by the Committee. However, the MHRA is considering publishing the correspondence with companies relating to the promotion of medicines. The agency will also publish an annual advertising regulations outcome report. Contrary to the Committee's recommendation, information received by the MHRA will remain confidential until a licensing decision has been made. However, upcoming legislation will require a public assessment report of a medicine's licensing history to be published shortly after a licence is granted. The MHRA has undertaken to publish assessment reports for licence renewals and safety update reports. Such safety reports will also be issued more frequently.
	One of the Committee's main recommendations was for a large-scale, independent review of the MHRA to be conducted. The suggested governing principles included the agency's need for independence from the Government and the industry, greater transparency, greater proactiveness in post-marketing surveillance, the prioritisation of new marketing applications, and the inclusion of lay members in policy-making decisions.
	That recommendation was rejected by the Government, although they stated, on page 18 of their response, that perhaps a four-yearly review of the operations of the MHRA should take place. If that were to happen, the terms of reference would remain to be decided. I remind the House that the terms of reference should consider methodology, timing and other issues. If the Government adopt that approach, as I think they should, it would be useful if there were a parliamentary input into exactly what the terms of reference should be, either on the Floor of the House or at least from the Health Committee. I am sure that members of the Committee would be more than happy to consider the issue.
	Both the report and the response stressed the importance of research and development for patients and the economy, and the need to maintain levels of investment by drug companies in the United Kingdom. However, the Government agreed with the Committee that there were occasional deficiencies in the design and conduct of clinical trials. Poorly designed trials have significant consequences for patient safety, as is shown by the tragic consequences of widespread prescription of the anti-arthritis drug Vioxx, mentioned by my hon. Friend the Member for Newport, West.

Kevin Barron: I do not disagree with that, and I do not think that anyone else would either, although obviously there is the issue of drugs coming on to the market and being patented. I am sure that the issue is considered, but not in the detail that the Committee would have liked. I am pleased that some agreement has been established.
	The report also raised the issue of ghost-writing, which relates to cases in which well-known doctors or academics put their names to research articles that they did not write. They may not even have seen the data referred to. The practice was criticised in the report, and has recently received media coverage as well. The evidence taken by the Committee was led in part by the Royal College of Psychiatrists, which submitted written evidence of its concern. Last week I received a letter from its president, Professor Sheila Hollins, who wrote:
	"I know that the Health Select Committee, in its report on the influence of the pharmaceutical industry, was very concerned about the failure of drug companies to publish all their findings regarding the efficacy and safety of drugs. This was also the most important issue raised in our submission to the Committee. I am aware that this situation is unlikely to have significantly changed; and many members of this college have grave concerns about the impact of selective publishing upon the trust placed in the pharmaceutical industry by patients and professionals alike."
	I have a great deal of trust in the pharmaceutical industry, but I hope that my hon. Friend the Minister will address the issue—highlighted by a recent case—at some stage, if not this afternoon.
	The Government's response makes no mention of ghost-writing, and does not respond to the Committee's recommendation that the industry adhere to guidance set out to ensure that publications are produced in a "responsible and ethical manner". Ghost-writing is widely thought to be standard practice in the pharmaceutical industry, as the Committee was told. As I have said, I was not a member at that time. However, witnesses from the industry denied that that was the case.
	In the past few months, the media have reported a number of cases of so-called ghost writing. In the past few days, The Times Higher Education Supplement and The Observer have reported a case in which researchers from Sheffield university, collaborating with a drug company, published findings without full access to the trial data. I do not know all the details, but I have seen the media coverage, and have received e-mails from one of the parties. I should like my hon. Friend to examine the position.
	Paragraph 199 of the report states:
	"Sir Ian Chalmers recommended that the industry adhere to guidelines set out in Good Publication Practice for Pharmaceutical Companies"
	—that was published in 2003, in Current Medical Research and Opinion—
	"that aim to ensure that publications are produced in a responsible and ethical manner. They include the need to publish results of all clinical trials of marketed products, and to report them in a balanced and objective manner. Authors should all have access to the statistical reports and data supplementing each publication. These guidelines are clear on the subject of authorship and the role of professional medical writers".
	The guidelines are then listed.
	I hope that the whole industry, all academics and all clinicians adhere strictly to those guidelines. It does not matter to me at this stage whether they are statutory, but I suspect that if they are not adhered to at some time in the future they may become statutory. We cannot require our clinicians, who work so hard both in hospitals and in primary care, to read everything, or cross-question on everything, that enters their domain. They need information about new drugs coming on to the market and about what they should and should not prescribe. Academics' reports, wherever they are published, should reflect accurately what has happened when a drug has come on to the market.
	I would like to move on to another aspect of the report—its coverage of NICE, which the hon. Member for Windsor mentioned a few moments ago. The Select Committee recommended that NICE receive additional funding in order to issue guidance more quickly. Indeed, it recommended increased funding in order to allow NICE to evaluate more medicines more quickly and argued that the consequent improvement in prescribing standards should make NICE cost-effective.
	NICE was criticised during the inquiry not for the actual work that it does—I do not think that anyone can criticise NICE for the brilliant work that it does—but in respect of the speed at which it issues guidance. Doctors, patients and the industry agreed that the wait for guidance to be issued was unacceptable. We have all heard the comment about the phenomenon known as NICE blight, whereby the NHS will not provide a treatment until it has been approved by the institute. Several witnesses who gave evidence to the Committee referred to it. The more thorough an appraisal, of course, the longer the delay. I spoke earlier about getting the balance right between safety and efficacy, it is important to recognise that in certain circumstances there can be delays. It is a delicate area, as we must all accept.
	The Government have recently looked into the new fast-track system of assessment. Fortuitously, I received a letter from the Department this morning. I had written on behalf of a constituent who had contacted me on 15 November about a life-saving drug called Velcade. I received a reply from the Minister of State, Department of Health, my right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy), which says:
	"A new, rapid process for assessing drugs and other treatments will be launched by NICE to sit alongside its standard process. The process will not be used for all appraisals but will be used initially to produce faster guidance on certain life-saving drugs used in a single disease or condition. NICE's new shorter appraisal process is designed to retain the integrity of its existing methodology but there is scope for NICE appraisals to take a longer track if the complexity of the topic warrants it. Publication of NICE guidance on specific drugs will be brought forward by between 6–15 months from the time originally planned. Work is starting immediately on five products, including Velcade"—
	as my constituent will be pleased to hear. It continues:
	"The first guidance developed using the new process is expected to appear as early as June 2006."
	I am very pleased about that, as it appears that the Government have seized on the issue. It is difficult on occasions to achieve the right balance, but hon. Members will know that the coverage of drug promotion in the media brings a great deal of pressure on NICE, on clinicians and, indeed, on Ministers. We have seen clear examples of that in recent weeks.
	It is a difficult area to balance, but there is an issue about the funding of NICE that the Government did not properly address. It is important to consider how much research it is reasonable for NICE to conduct annually. Somewhere between 200 and 300 medicines and drugs receive a licence every year in this country, and I believe that NICE looks into between 30 and 40 of them. The new process may allow NICE to investigate more. No one would expect all licensed drugs to go through the NICE process, but it would be good if we could get rid of the NICE blight. If that is the intention of the new appraisal process, I am pleased to support it.
	The report also suggested that NICE extend its role to give advice to industry on the design of clinical trials likely to yield clear results and to be useful in the production of NICE guidance. That issue was not covered in the Government's response, but I believe that it is a very good idea. On a daily basis in clinical trials, consultants and doctors throughout the country, working alongside the pharmaceutical industry, give advice about what is happening within the NHS. We do not know much about it, as it is not often discussed, but most drugs are developed in situ in our hospitals and sometimes in the primary sector. The more collaborative we can make the process, the better. We want people to have confidence in NICE and what it does, so advice from NICE about what is going on in respect of guidelines for treatment, drugs and care is also important. Clearly, the Government and the pharmaceutical industry should look further into that in future.
	I have brought up many issues in my speech and I am sure that hon. Members who were Select Committee members at the time will have further issues to debate. The investigation into the pharmaceutical industry—the first since 1914—was wide ranging. I am pleased that the Government responded well in certain respects, but they could have made a fuller response in other respects. My final comment—to the Minister, hon. Members or anyone else who is listening to or reading the debate—is that the Health Committee will be looking into the developments emerging from this report and response for many years to come.

Julia Goldsworthy: I was not aware of that. I am not sure how the ABPI could provide flights to and from seminars at that low value, even given the existence of some very low-cost carriers. There may still be some devil in the detail and of course, this code remains voluntary.

Julia Goldsworthy: I recognise the hon. Gentleman's concerns, but of course, although the problems associated with patient safety and access to drugs can in some respects be dealt with through improved regulation of the pharmaceutical industry, that is not the sole determinant. It is clear that the Government's behaviour has had a significant impact, and stories in the media have a fundamental impact on the public's awareness of drugs. Moreover, the Government have a major influence on the ability to get new drugs to patients quickly.
	We have heard much this afternoon about "NICE blight" and the delays in the licensing programme, but to what extent are those delays due to NICE? My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) recently tabled written parliamentary questions on this issue, and the answers show that it takes the Government nine to 10 months to produce the list of drugs that is subsequently sent to NICE for licensing approval. That is another part of the delay in getting drugs to patients who may need them as quickly as possible. I should be grateful if the Minister explained the reasons for this delay and what measures his Department are implementing to speed up the process.
	There is also the apparently contradictory position whereby drugs need to be licensed by NICE before they become widely available, yet in some cases—such as the recent and well-known one involving Herceptin—statements have been made implying that there should be widespread uptake before the licensing process has been completed. What assessment has the Minister's Department made of the immediate and long-term financial implications of making such drugs available? On Herceptin, we know that it is not a question simply of the cost of the drug; there are also costs associated with echocardiograms and ongoing monitoring. Herceptin will of course make a huge difference to some women with early-stage breast cancer, but how do the Government envisage that these costs should be met, given the existing pressures on many budgets? The cost of such drugs is only rising, so what is the long-term sustainability of their prescription? There is a real concern that post-2008, when the increase in NHS funding tails off, funding for many such drugs will experience a hard landing.
	Finally, in contrast to moves to increase the transparency of the data—

Julia Goldsworthy: It is of course important to make such drugs available as quickly as possible, but certain systemic problems have been highlighted, such as "NICE blight". We need to take steps to prevent such exceptions from having to be made.
	Finally, given moves to increase the transparency of data relating to clinical trials, why do negotiations with the Treasury on the pharmaceutical price regulation scheme take place in such deep secrecy? Do the Department plan to make this process more open?
	I turn finally to other potential dangers and difficulties for patients—

Paul Flynn: I believe that this report is among the three best that I have seen in my 20 years in Parliament. I believe that it required a response from the Government that reflected the courage and thoroughness of David Hinchliffe and the other members of the Committee. Sadly, the Government's response is lamentable. Not only did they not respond to the Committee's clear and important calls, but they ignored many of them altogether.
	I will go along with what has been said about the enormous, miraculous progress in pharmaceuticals in the past 100 years or so. Tens of thousands of people would be dead today were it not for drugs, particularly the recent advances in cancer drugs. I make no criticism of the science involved or of that part of the work of the industry whatever. We and the Committee, however, should be very critical of the dark side of the industry—the disease-mongering, the medicalisation of society, and the way that it abuses all the dark arts to encourage all of society to believe that we are ill and need a pill every day. Recently, the greatest increase has been in the incidence of depression, for which prescriptions have risen by more than 400 per cent. in a decade. In the great majority of cases people are suffering from mild depression, but we are taught to believe that if we are sadder today than we were yesterday, we are ill, and we need medication. That is useful for the pharmaceutical industry.
	The worst aspect of that was contained in report that came out of America less than a week ago, which suggested that many two to five-year-olds need Ritalin or anti-psychotic drugs. As a consequence of this view, in America, one in seven children are on Ritalin—similar to amphetamines in some ways—and worse drugs. The ambition of the pharmaceutical industry is to get us all taking those drugs, which are of questionable value.
	I want to consider in particular the effect of the pharmaceutical industry's strategy on us as MPs. About an hour and a half ago in this Chamber, a Member called for the acceleration of the supply of Velcade, I think, which my constituents can get, but many other Members' constituents cannot, because it can be obtained in Wales but not here. There was warm support and almost universal approval for accelerating NICE's processes. I briefly pointed out the results of that in an intervention.
	Let me give one story as an example. Yesterday, I received an e-mail from somebody trying to persuade me to raise with the Minister the health problems of obesity, which are well known and a serious matter. I noticed that the e-mail came from a well known lobbying company. I therefore got in touch with it, and I asked it who was paying its wages. It turned out to be a group of people called the obesity council. Who pays the obesity council? It is the drug industry—the people who sell slimming aids.
	A few weeks ago, I received a letter that interested me greatly, as I had a constituent suffering from pancreatic cancer. The letter was about a new wonder drug called Tarceva, of which I had never heard. I got in touch with the letter's writer, and I felt that I must investigate the matter if such a drug would help my constituents. On investigation, however, it turns out that the cost of prescribing this drug will be £16,000 a year. Its effect was to increase the life expectancy of pancreatic cancer patients by 12 days, and it had adverse side effects including death in 10 per cent. of the patients involved. Increasingly, MPs are being approached to use our office here to put forward a case for the drug industry. That is a thorough abuse of our position. From the Health Committee, however, we had a splendid clarion call against the great abuses that have occurred.
	The Medicines and Healthcare products Regulatory Agency and the Association of the British Pharmaceutical industry work jointly together, hold joint seminars and campaign together. The MHRA, the regulatory body, is funded 100 per cent. from the pharmaceutical industry. The pharmaceutical industry calls the tune. We could give numerous examples of that. Perhaps the worst was Seroxat, on which I have had two debates in the recent past, before its problems were discovered. The MHRA set up a sub-committee to look into the issue, but it had to disband after some nine months because the majority of the members had a financial interest in the company that produced the drug. The sub-committee had to be re-formed and progress was very slow.
	The Health Committee invited me to give evidence and I was able to raise the question of the influence that drug companies have on bodies in this House, such as the all-party groups which have well-intentioned, good hon. Members on them who are trying to reduce the effects of diseases. However, almost all of them are infected by the influence of the pharmaceutical companies. An example that applies to Seroxat and the treatment of mild depression was revealed in a book that I sent to all the members of the Committee before it started its work on the issue. The book is called "Medicines Out of Control?", by Charles Medawar. It asks what would have happened if we had gone to see Sigmund Freud when he practised as a doctor. He gave all his patients and friends, and took himself, a medicine he knew that was believed to improve people's mental health and stability. That medicine was cocaine: it was the popular drug of the time. A later popular drug was bromide, which creates its own form of psychosis, called bromism, which was a scourge of society at the time of the first world war.
	For an awful period in the 1960s and 1970s, diazepam—or valium—and other similar drugs were prescribed like smarties. That caused great distress and did very little good. There was also the experimental period of the mental health industry in the 1950s, with the inducement of deep psychosis, lobotomies, leucotomies insulin coma therapy and electroconvulsive therapy. People were used as guinea pigs and suffered greatly. Many of those therapies are rightly no longer used.
	More recently, we have had the tricyclics, which were regarded as wonder drugs, but they are now seen as old-fashioned and have been replaced by selective serotonin reuptake inhibitors—SSRIs—of which Seroxat is one. When the campaign against Seroxat was mounted by a few courageous people outside the drug industry, the drug companies mounted a ferocious campaign to ensure that the voices who were protesting about the dangers of Seroxat were muffled. For example, Depression Alliance, a patient group that is virtually a creature of the pharmaceutical industry and gets 80 per cent. of its funding from it—as it has admitted to me—criticised those people who drew attention to the dreadful effects of Seroxat in turning depressed people into suicidal people.
	The organisations that emerge with great credit are those that take not a penny from the pharmaceutical industry, such as MIND, which continues to act in the patients' interests. Many so-called patient organisations still receive instructions from and carry out the work of the pharmaceutical industry, and some otherwise splendid organisations are affected. For example, on the day that Vioxx was banned, I went on to the Arthritis Care website. I greatly respect that organisation and it does fine work in encouraging the use of non-drug interventions such as exercise in the treatment of arthritis. On that day, its website told people not to panic if they were taking Vioxx. That drug has been identified as causing 144,000 heart attacks and strokes in the US. I would have thought that reasonable advice in such circumstances would be to panic, if people were taking such a drug. The website also advised people to visit their doctor and follow their advice about changing to another drug. However, it is significant that the website of that respectable organisation contains a notice saying that the site has been refurbished with help from Merck Sharp and Dohme, the company that makes Vioxx. Even a worthy, conscientious organisation such as Arthritis Care must be influenced in some way by the fact that if it upsets the pharmaceutical companies or fails to do their bidding, it will lose some of its staff or funding. Understandably, the Committee recommended action on those patient groups, which should declare all significant funding. It also recommended that the Government should make changes to charity law to ensure that that happens. Unfortunately, the Government have stated that self-regulation should be the first resort in improving fundraising standards, so no action has been taken, although the Home Secretary maintains reserve powers.
	This House is infested with organisations that, on the surface, are perfectly good. I had some influence in one of them—I shall not name it—and I see that it is now organising a relaunch with help from a lobbyist. Who is paying the lobbyist? It is one of the pharmaceutical companies. Their influence is everywhere and their tentacles stretch into the Government, the patient bodies and elsewhere.
	The key, and most dramatic, moment in the Health Committee inquiry was the unbelievable evidence about the inducements given to clinicians and others to use particular drugs. One of the questioners asked whether the free trips, the holidays and the chance to take one's wife, husband or girlfriend to the Bahamas or the Alps had any effect. The witness replied that they did not, but that articles in the British Medical Journal and The Lancet did. The point, made with great force, was that the way to influence public and medical opinion was to get articles written by authoritative figures in those journals.
	As someone with scientific training who has always defended double-blind and properly peer-reviewed trials, my greatest shock in the last couple of years was when the BMJ published an article two years ago, giving examples of reports presented in the medical journals—reports that had got past the very suspicious editors—in which the conclusions did not match the data. The data said something and the conclusions said something else. There were examples of how this was done; the pharmaceutical companies write most of the reports and hawk them round for others to sign and approve. They get some figures and they provide some fat fees.
	This element of ghost-writing, raised by my right hon. Friend the Member for Rother Valley in opening the debate, is a matter of great concern, and it is continuing. We saw the accounts given by Dr Blumsohn in last week's edition of The Observer. I met this gentleman and heard what had happened in his case. People talk about life and death; often, it is death and death. The number of people who have lost their lives from an adverse reaction to drugs is enormous. In America, it is claimed that the fourth-largest cause of death is adverse reactions to drugs.
	The Leemon McHenry Hastings centre report pointed out that the companies first select the data that promote the drugs. They file away the results that are unfavourable and buy the right academic credentials to sign a ghost-written article produced by marketing department staff or by public relations agencies employed by the company. What are we to regard as the fundamental science, the authoritative work, to which doctors and physicians look if they want to approve a new drug? We know these articles are being ghost-written and the case of Dr. Blumsohn, published last week, made it clear that the companies refused to give him the data on an article to which his name was attached. They claimed his authority for the article and he had not seen the data.

Paul Flynn: We all hope so. Like many, I thought that having a rational and genuinely independent body to look at these matters was a fine reform. The difficulty is the pressure that we all feel as human beings. If a member of our family or a close constituent wanted a drug, we would go along with it, even if there was only a 1 per cent. chance of success, and would want to hurry NICE along. But if we as politicians take a decision, as we should, we should look at what happens with rushed approvals. The reason that Seroxat caused problems was that it was approved off-label for people under 18 when it had not been trialled.
	As I said earlier, a fairly recent report, published since the Health Committee report, said that we withdrew 24 drugs in the long period between 1971 and 1992, while the United States withdrew only nine. We had approved all those 15 other drugs, which did a great deal of damage, when America had refused to approved them. A balance must be made—this is often impossible—when patients who suffer from terminal diseases demand drugs that might have even a very slim chance of postponing the inevitable. They want us to approve those drugs, and we politicians tend to put pressure on NICE to give quick decisions.
	The evidence is that that the faster the licensing process works, the more frequent the problems and a greater number of lethal reactions take place. If we continue to accelerate our review times, there will be more adverse reactions. That is a difficult case to put across, and it is perhaps almost impossible for us, as politicians, to do so when we see someone sitting in our surgeries telling us that they have a fatal disease and want a drug that might be available in France or Wales, but not elsewhere.
	Dr. Blumsohn spent a year requesting to see the full data on which the work that was published under his name was based. He was one of two lead authors. Two years after raising his concern, he was suspended from his university post. In The Observer last Sunday, Proctor and Gamble is reported as saying that it is "standard industry practice" not to hand over all data to professionals. That seems extraordinary, and it is regrettable that the Government have failed to respond in any way to that crucial issue in their response to the report. That is the key issue turned up by the Health Committee.
	No reforms are proposed for the Medicines and Healthcare products Regulatory Agency, although it has been criticised in debate after debate in the House because of its nature, organisation and funding. That was another main concern that the Government left untouched in their response. The MHRA is still 100 per cent. funded by the industry and the system relies on self-regulation. There is talk of reviews every four years, but a thorough, independent review was not agreed to.
	We have seen the pathetically weak response from the ABPI, which was mentioned by the hon. Member for Falmouth and Camborne (Julia Goldsworthy). An early-day motion was tabled last night—it has amassed one signature so far—and I tried generously to amend it to point out that there was presumably some support for the ABPI in praising its new code. As the hon. Lady rightly said, the code of practice has been described as weak by the BMJ and by the Drug and Therapeutics Bulletin. She rightly made the point that the ABPI has never expelled a member. It has never even forced one of them to publish any corrective statement, although there are dozens of examples of misleading advertising and products that should not have been marketed as they were. We are dealing with a defensive group, lobbying for and defending the industry and putting at the top of its priorities not the concerns and health of the public, but the financial interests of the pharmaceutical industry.

David Amess: The hon. Member for Newport, West (Paul Flynn) has strong views on these issues. He and I have discussed them on various occasions, and we are joint officers of a group that is particularly interested in such matters. I am not sure how widely the hon. Gentleman's views are shared in the House. He may prove to be a Churchillian figure and eventually his views will be shared by a majority of us. As a member of the Select Committee, I am grateful for his support of our views.
	The inquiry into the influence of the pharmaceutical industry was the idea of David Hinchliffe, our excellent former Chairman. I am sure that his successor, the right hon. Member for Rother Valley (Mr. Barron) will prove equally excellent. It is a shame that David Hinchliffe, who retired at a relatively early age at the last election, is not with us this afternoon. He was keen to hold the inquiry, a highlight of which was our visit to Australia. I warn the House that I shall shortly be submitting a photograph taken on that trip to the caption competition in The House Magazine. I was not in the photograph, which shows a number of my colleagues who look like Snow White and the seven dwarfs. I hope that the winner of the caption competition will invite me to enjoy a glass of whisky.
	As the hon. Member for Newport, West said, unfortunately only two members of the Select Committee responsible for the report are in the Chamber today. That is no discourtesy to the House. One of the members who participated in the inquiry, Patsy Calton, tragically died at an early age. As several other such members were regrettably defeated at the last election—I say that genuinely—the membership of the Committee changed.
	The report is excellent. Following on from a point made by the hon. Member for Newport, West, may I say to the Minister that we are just a little disappointed that in contrast to many responses to the report, the Government seem to have said no to more of our recommendations than is usual? I would appreciate hearing from the Minister why the Government were so firm.
	I now part company with the hon. Member for Newport, West because there is a danger that this is a debate in which we will want to have our cake and eat it at the same time. After hon. Members have heard my speech, they might say, "Hang on, that is exactly what the hon. Member for Southend, West has just done." The United Kingdom owes a great debt of gratitude to the pharmaceutical industry for its funding of significant amounts of medical research and the consequent reductions in cost to the national health service.
	There is an argument that the regulatory burden on developing new medicines has increased markedly over the past two decades and that the balance between risk and benefit has been tipped a little too far in favour of the former. The National Institute for Health and Clinical Excellence is an important body, and my hon. Friend the Member for Windsor (Adam Afriyie) has referred to it several times today. However, our report said that the recent cut to its budget might have a significant impact on the speed at which new medicines reach patients. The Government's recent moves to extend the prescribing power of nurses and pharmacists, which many of us welcome, might render it more difficult to restrain the growing influence of the pharmaceutical industry and the increase in the medicalisation of our society.
	I hope that I will not regret making this statement, although it will please the hon. Member for Newport, West, but there is a view in certain quarters that we can sometimes be seen as a nation of hypochondriacs. We all know about those who are really ill and perhaps never even go to a GP, while other people always think that they are dying, although they invariably live to be 100 or more. All the new products on the market to make us look more wonderful and feel better pressurise people to think, "It's out there; let's have it." However, as the hon. Member for Bolton, South-East (Dr. Iddon) said, that is perhaps due to accountants and advertisers, rather than scientists, who do such wonderful work.
	There was a theme throughout the Health Committee's inquiry that highlighted the increased medicalisation of our society. Every malfunction in the human body can now be diagnosed as a defect and some sort of medication is available to treat it. It is thus no surprise that self-medication is on the increase and that GPs are put under more pressure by their patients. People can now access websites on which they can find out about whatever their problems are. I was interested by what was said about pancreatic cancer because many of us deal with constituents who come along and say, "My loved one is in dire straits. Here's this product; what can you do to try to make it available?" It is difficult to deal with such a situation.
	The phenomenon is symptomatic of the pharmaceutical industry. It can be argued that the industry has been left to its own devices for too long. That was the thrust of the Health Committee report. The industry can target not only general practitioners, hospitals, treatment groups, medical journals and professional bodies in distribution campaigns but individuals as well. The Health Committee thought that that practice put genuinely ill and vulnerable people at risk to some extent. Everyone, including patients and consumers, should be protected from pharmaceutical companies' persuasive product pushing. As a Conservative, I am certainly not in favour of the nanny state, but a balance must be struck and there is a role for Government, which is why we are genuinely disappointed that more of our recommendations were not accepted. The powers of the statutory regulator—the Medicines and Healthcare products Regulatory Agency—should be strengthened to ensure that the evidence produced by pharmaceutical companies truly reflects the findings of their clinical trials. That research should be undertaken in a professional manner, and the disadvantages as well as the benefits of licensed drugs should be well known to people who prescribe and use them.
	I welcome the revised and updated Association of the British Pharmaceutical Industry code of practice, which was announced on 16 November. It will govern the UK-based pharmaceutical industry's relations with health care professionals from January next year. It highlights the key priority of patient safety, and sets guidelines and restrictions on pharmaceutical companies' advertising strategies. It bans promotional competitions, including one cited in the Library briefing. In September 2005, a dentistry magazine featured a promotion for the drug Periostat that included a competition to win an iPod Mini. I have not entered the competition, but I am tempted to encourage my children to do so, as they all want iPods for Christmas.
	Responsibility for ethical practices should not lie with the pharmaceutical industry alone. The Health Committee strongly recommended that doctors should be obliged to declare significant sums of money or gifts that they receive as hospitality, and that they should register them with their professional bodies. The profession will say that only a tiny minority is involved but, even so, we believe that those gifts should be registered. Likewise, the ABPI code tightens the rules on hospitality, stating that delegates to company sponsored events, as we have heard, should only be flown economy class. However, it does not go as far as banning provision for five-star hotel accommodation, which is a shame.
	The ABPI says:
	"There are rigorous guidelines for conducting clinical trials and a code of practice governing all promotional activities."
	Despite those assertions, a number of practices have emerged that are clearly against the public interest, including the suppression of negative clinical trial findings resulting in a body of evidence that does not allow a transparent view of a product's risk-benefit ratio. That is especially important, as guidance such as that produced by NICE is based on such published evidence.

David Amess: I like where my hon. Friend is leading me and was aware of his interest in the matter. The Minister has heard our exchange, and I am sure that the general public will become increasingly interested in what is going on. We certainly need to clarify the matter.
	It is vital that new drugs are proven to be of real therapeutic benefit to patients, and clinical trials should therefore aim to produce health outcomes that are relevant to patient care rather than relevant to the profits made by pharmaceutical companies. That is why the Health Committee made the sensible recommendation that better communications should be established between the Medicines and Healthcare products Regulatory Agency and the pharmaceutical companies in the early development stages of a drug. There should be more post-licensing monitoring of medicines, which requires systematic appraisals of drugs on the market. I hope that the Minister will comment on that point in order to reassure the Committee.
	There is no doubt that medicines contribute enormously to the health of the nation. The hon. Member for Newport, West is not present, but I was concerned by his remarks about drugs to assist people who are depressed or who have other mental health problems, because I think that he overstated the case against those drugs. For many people, they are the source of a better quality of life, negating the need for surgery or other invasive treatments.
	Economically speaking, the production of pharmaceuticals is the third most profitable activity in the United Kingdom after tourism and finance. The UK should be very proud of the many achievements of its domestic pharmaceutical industry, as it has an excellent global reputation for scientific research, accounting for 10 per cent. of global research and development expenditure.
	In order to maintain that wonderful reputation, the Government must act to protect the public, especially the elderly and less well-off, who are the biggest users of prescription-only treatments but also the most vulnerable people in society. It would be unrealistic to rely on the pharmaceutical industry to protect the public interest through self-regulation, but neither must we over-regulate through the statutory body. All restrictions on pharmaceutical companies must be targeted, and they must have a clear purpose in the promotion of public safety.
	I believe that the United Kingdom's pharmaceutical industry is a respected and highly lucrative business, but I also believe that it is the Government's responsibility to ensure that it remains so.

Richard Taylor: I do not think that there was any hard evidence that that merger had produced an increase in research, but I do not think that we asked the question, so regrettably I cannot help the hon. Gentleman. The one thing I remember only too well about the Glaxo merger with SmithKline is that I had to sell my shares so that I would not have to declare an interest.
	Several Members mentioned "me-too" drugs, the duplicates or near-duplicates of existing drugs, which are relatively cheap for companies to produce. We were rather down on them because of the number available. Three or four beta blockers will provide all that is needed in terms of variety, as will a small number of non-steroidal anti-inflammatory drugs. We issued a plea for a wider distribution of really effective local drug and therapeutics committees working over acute and primary care trusts to introduce some control to prescribing of that kind.
	Clinical trials have already been mentioned briefly and several recommendations in the report refer to them. We wanted an independent register and records kept of negative trials and of drugs that were terminated due to side effects. We wanted to ensure that comparator drugs were used and that the particular comparator drug was the right one to choose. We wanted drug treatments to be compared, where possible, with non-drug treatments. It is not clear from the Government's response whether they have taken all those details into account; they seem rather to hide behind European rules.
	I feel very strongly about the promotion of new drugs. Our recommendation 5, which was not answered, stated:
	"The aggressive promotion of medicines shortly after launch, the sheer volume of information that is received in its many forms by prescribers and the 'promotional hospitality masquerading as education', in the absence of effective countervailing forces, all contribute to the inappropriate prescription of medicines."
	I thought that that was a powerful recommendation.
	I am interested to hear other hon. Members' comments on the Association of the British Pharmaceutical Industry code of conduct. I am slightly less dismissive of it than others. I agree that there may be an element of window dressing, as mentioned by the hon. Member for Newport, West, but I hope that it is at least a first attempt at self-regulation. In other inquiries, such as the one into obesity, the Health Committee has recognised that self-regulation of the food industry was probably a more practicable measure to aim for than strict regulation from outside. I will study the code of practice carefully. I am not sure whether it covers either ghost writing or fees to experts, which are important matters.
	Returning to the intensive promotion of new drugs, I would like to refer to another recommendation. To avoid confusion, it was our recommendation 33, though it appears as recommendation 6 in the Government response. Our recommendation stated:
	"The intensive marketing which encourages inappropriate prescribing of drugs must be curbed. Present methods of supplying independent information, as described by Lord Warner, are inadequate."
	We went on to recommend that
	"the promotional material for a new product"
	should be "pre-vetted by the MHRA". I believe that that is going to happen. We further recommended that
	"consideration be given to limiting those who can prescribe a new drug in the two years following launch. Drug and Therapeutics Committees would be well-placed to implement this."
	That provides another function for such committees.
	In their response, the Government agreed that there should be proper controls, but they subsequently lost the plot completely, saying:
	"There is no indication that the measures currently in place are not effective. The fact that generic prescribing has risen to nearly 78 per cent. (in 2003) clearly indicates that clinicians are writing prescriptions generically and not by individual company product."
	One cannot write a prescription generically for a drug that is new and under patent because it effectively does not yet exist. I was not very impressed with that aspect of the Government response.
	An example of the rapid uptake of a new drug causing problems is of course Vioxx. It has been referred to by several Members today, but I will go over some of this ground again because it is so important. Vioxx was launched as an answer to all the upper gastrointestinal problems that undoubtedly occur through the use of existing anti-inflammatory drugs for various forms of arthritis. It was introduced in 1999 and withdrawn in September 2004 when work in America showed how dangerous it was from the point of view of causing heart attacks and strokes.
	To express a slightly different view, we lost what was thought to be a potentially useful drug due to the unpredictable side effects brought to light by very widespread, very rapid prescribing. I have spoken to drugs firms about this and they claim that in fact, it was a good thing that Vioxx was prescribed so widely, because doing so brought the side effects to light much more quickly. I do not quite follow that argument.
	During the inquiry, we visited University College London hospital to hear about its Use of Medicines Committee. We were incredibly impressed with its drug formulary, which is used not only by the hospital trust but by the nearby primary care trusts. Because members of those trusts are on the committee, it is also well accepted by the GPs in the area. Its prescribing levels of Vioxx—surprise, surprise—were lower than the nationwide average because it had careful guidelines. It took the view that this is a new drug and no one knows entirely what is going to happen, so we should be careful with it, please.

Charles Walker: I am grateful for the opportunity to speak in this important debate. I thought that I would need to have my boxing gloves on, metaphorically speaking, to take on the hon. Member for Newport, West (Paul Flynn), but as I listened to his excellent speech, I found that I agreed with much of it.
	I must first declare an interest in that Merck Sharp and Dohme is based in my constituency. I am pleased to have that company there, it is a good employer and I hope that it continues to operate out of the UK as well as other countries. The pharmaceutical industry plays an important role in the UK. It employs many hundreds of my constituents and across the country it employs many tens of thousands of people. It spends a vast amount of money on research—it should be remembered that only one or two in 100 drugs on the drawing board reach fruition. Of course, pharmaceutical companies need to make returns on those one or two to fund future research. I have no objection, therefore, to pharmaceutical companies marketing more aggressively than perhaps the hon. Gentleman would like to see them do, or to their making a profit.
	Before I became a Member of Parliament, I worked in health care as a PR person. That is why I listened with great interest to the hon. Gentleman. At the tender age of 27, I was responsible for promoting certain diseases, one of which was osteoporosis, and 11 years ago, it probably needed promoting. The system works as follows. Some motivated and passionate charities are connected with certain diseases, and they have very little or no money. In such cases, generous pharmaceutical companies with a treatment for one of those diseases come along and sponsor some of the charities' activities. As I said, we needed to promote osteoporosis because so many people, especially women, were afflicted with it, and politicians—we had a Conservative Government then—did not take it seriously or see it as a priority.
	I have to say that I now regret my involvement in promoting some diseases, especially depression. While some people do suffer from serious depression and SSRIs are useful drugs for treating it, I am concerned that too many doctors, for whatever reason, prescribe SSRIs without taking the time to understand the causes of their patients' problems. I understand, from talking to many of the same charities to which the hon. Gentleman has talked, that sometimes a patient gets less than five minutes and to get them out of the door they are prescribed SSRIs, which can have serious side effects for some people and cause great discomfort. They can also be very difficult to come off. I hope that as a result of this debate the Minister will take away the concerns about SSRIs. Perhaps we need a process of education for GPs to ensure that they take more time to understand the root causes of people's problems before prescribing a pharmaceutical solution.
	I am glad that the ABPI recognises some of the concerns about support for patient groups and paid-for doctors writing in support of drug companies' solutions to an illness. Coming from a PR background, I am aware that there was always a difference between an advertorial and an editorial, and perhaps we have seen editorials that should have been branded as advertorials. There should be greater transparency. Pharmaceutical companies should make it clear which groups they support, be they academic or charities, and when a doctor or professional writing in support of a treatment is in receipt of funding from the company producing that treatment, that should be made clear.
	This was going to be a short speech, so I shall conclude by agreeing with the hon. Member for Bolton, South-East (Dr. Iddon) on the danger of counterfeit medicine and internet pharmacy, 99.99 per cent. of which is unregulated and operated from places such as Tonga in the Pacific. Drugs that are sold back to the UK may be as harmless as sugar but, for example, if a woman were to take Propetia, it could have severe, possibly even life-threatening, implications for her health. I hope that I can join the hon. Gentleman, perhaps in a future debate in Westminster Hall, to explore that problem, which was not covered by the report.
	Madam Deputy Speaker, I thank you for allowing me to take part and I thank all Members for listening to me so closely.

Adam Afriyie: It is a pleasure to participate in this debate. We should be thankful to the pharmaceutical industry, which, over the past couple of hundred years, has introduced cures and treatments for ailments that affect many people. We should be thankful to the Select Committee for its excellent report and recommendations. We should also be thankful to Parliament for establishing the National Institute for Health and Clinical Excellence, which does good work in regulating what comes onto the market as an acceptable treatment.
	The Select Committee report and the Government response are concerned with life-and-death issues, particularly with regard to the speed with which treatments reach the market. I should like to raise three brief concerns, the first of which is the funding available to NICE. There was a clear recommendation that its funding should be increased. The Government response was fairly clear: they would look at the matter in the round in the future. It is slightly more urgent than that. If we expect NICE to do its work, the fact that so many drugs are coming on to the market and so many clinical trials are taking place mean that its funding needs to be increased, and soon. The £3.5 million that was withdrawn resulted almost directly in one of the appraisal panels being closed. Perhaps the Minister can say a few words about that in his response.
	My second concern relates to the recommendation from the Secretary of State that Herceptin be fast-tracked and that PCTs should begin allowing women with early stage breast cancer to use the treatment. I welcome that decision—by all accounts, the drug is effective—but it raises concerns and questions. On what basis should a Secretary of State for Health intervene in the process? On what basis should the Secretary of State select a drug or treatment for fast-tracking? Surely there should be overt, rational and robust guidelines that are open for everyone to see, so that any decision is not made as a result of public pressure or, dare I suggest, PR pressure from the pharmaceutical industry. Although the decision raises some questions, I was delighted with the recommendation.
	My third concern is that medicines reach the market on the basis of robust evidence. I said earlier that if NICE is unable to see all of the evidence, clinical trials and data on a treatment, it is not necessarily in a position to make a sound judgment. If it sees only the published reports of clinical trials, it is not seeing the full picture and it cannot necessarily make a fully informed judgment.
	The House and the Government have a duty to protect people from unsafe medicines, and NICE does a good job in the circumstances. However, I urge the Minister to take a good look at, first, the guidelines for NICE to ensure that it can consider all the evidence involved; secondly, the basis on which the Secretary of State for Health can circumvent or intervene in the process of drug prescription; and, thirdly, the funding available to NICE, so that, as patients and the pharmaceutical industry make more demands in the future and the evidence becomes clear that certain medicines look useful, those medicines can be processed, examined and reviewed very quickly by an excellent institute.

Andrew Lansley: I understand the point that the hon. Gentleman has been making and I do not doubt his long history of work on the subject. He does an important job and I do not dispute that. We need people in this place who come at the arguments from many different angles, but his argument seems to be that the bottle is one tenth empty. We must remember that the bottle is nine tenths full; the pharmaceutical industry has made and continues to make a remarkable contribution to the public benefit by improving our health.
	One of the Government's central messages is about the reduction in mortality from coronary heart disease, but they know perfectly well that that has occurred throughout the world as a consequence of the introduction of statins. That is but one example. The hon. Member for Bolton, South-East (Dr. Iddon) rightly gave the hon. Member for Newport, West a short lecture on the range of benefits that the drug industry has brought us.
	The hon. Member for Bolton, South-East was also right to point out the risks associated with both parallel trade and internet trading, which are not necessarily the same thing. Parallel trade is not illegal. It is a consequence of the fact that we do not have a single market in pharmaceuticals, nor are we likely to. I am certainly not saying that we should leap to that situation. We have to acknowledge that large price disparities, especially in parts of Europe, can have a substantial impact on trade and can dramatically undermine the intentions behind the pharmaceutical price regulation scheme. We need to be aware of that and, if necessary, adapt the PPRS in response. I shall return to the PPRS later.
	Counterfeit trade is illegal and extremely harmful. Everything I hear confirms that the scale of internet trade in counterfeit drugs is rising. Whenever there are questions about the preparations for pandemic flu and the availability of Tamiflu, the counterfeiters try to trade on that public concern and satisfy the demand.
	We have not talked much about the necessity for public information. There is a range of possibilities for better informing the public about the availability of drugs and about why some medicines should be prescription-only. We need to think hard about the circumstances in which they should become pharmacy medicines. That has been advantageous in the case of statins and the same may be true of antiviral drugs in the future.
	We must also consider the public understanding of risk, about which we could talk for a long time. If the public become direct participants in reporting adverse drug reactions and adverse events, as they will under the yellow card scheme, they need to be much more aware of risk and the kind of adverse event that we anticipate. I am sorry that there was not more discussion during the debate of the Government's response to the yellow card scheme, which is important, although we should not get too carried away. The yellow card scheme in the UK did not disclose the problems with Vioxx, nor did the Medwatch scheme in the United States. As the Select Committee pointed out, they were largely disclosed during large-scale, long-term trials, designed to establish the efficacy of non-steroidal anti-inflammatory drugs in the treatment of other conditions. That illustrates that the longer one continues the process, the more trials one does and the more patients who are exposed to a drug, the more likely one is to establish safety data. I am not a scientist, so I cannot explain how the procedure works, but I am confidently assured that although trials that establish efficacy, safety and quality for licensing purposes are immensely expensive, there are many reasons why their scale is not necessarily sufficient to establish safety against a range of untoward events. Such trials disclose immediate safety events in controlled populations, but they do not reveal less common events that could occur in larger populations. That explains why we must think about post-licensing surveillance, which is important, as the Committee and the right hon. Member for Rother Valley rightly pointed out.
	There are several factors that could help us to achieve that. The national health service could be an important international organisation in the process. It would help the pharmaceutical industry in this country if we could use effectively the connecting for health programme, the electronic patient records and everything that goes with them to create population-wide databases that would give us good information about adverse events. We have the general practice research database, but if that were to expand and migrate into the connecting for health programme, it would help us enormously. Although we have prescription-event monitoring at the moment, I understand that about 30 per cent. of GPs do not participate in it. We need something that will be effective across the board and not likely to be affected by any distortions and biases that might occur due to the self-selection of participants.
	The document "Safer Medicines", which was published by the Academy of Medical Sciences only two weeks ago, makes interesting reading. I do it an injustice by picking out only one or two aspects of it, but it addresses useful matters that have not been mentioned. The document refers to conditional approval, which would occur if licensing meant not simply saying that a firm could market a drug without any further conditions, but saying that there were as yet unproven safety considerations that would have to be addressed through the subsequent use of the drug. If a company were able to extend the life of patent protection while it continued to acquire data, it would be in its commercial and economic interests to undertake much of the larger-scale work that would be necessary to acquire data from a wider population who were using a drug that was effective for their needs, rather than only those involved in clinical trials. It would thus be understood whether any contraindications associated with the drug would affect its final licensing approval. The academy did not recommend such a scheme, but as it discussed it, I thought that it would be an interesting matter to put to the Minister for further debate.
	Secondly, the academy referred to the importance of using European data. Of course, the sooner one arrives at a point at which a large population is using a drug, the more likely one is to identify adverse events that might occur. The academy refers to the need for an international co-ordinating centre on drug toxicity and the ability to undertake DNA sampling. The beauty of such an approach is shown by the fact that we increasingly find that drugs might be especially effective in circumstances in which people have a genetic predisposition. For example, Herceptin is likely to be effective for the 20 per cent. of women with breast cancer who are HER2-postive. Equally, there may be genetic predispositions towards adverse drug reactions, and we must focus as much on that possibility as on the positive opportunity to find drugs by understanding people's DNA responses. If we can do so, that will provide another positive benefit.
	My hon. Friend the Member for Southend, West (Mr. Amess) made a good point about tuberculosis testing and the Mantoux test. If we are to have a NICE mechanism whereby the NHS undertakes evidence-based appraisals of clinical and cost-effectiveness to inform its clinical activity and priority setting, and if vaccines are available as alternatives to drugs and chemical compounds for the treatment of prostrate cancer and other cancers, I can see no reason why those vaccines should not be subject to NICE analysis. Indeed, that would have a positive benefit, as it would be more transparent. I have voiced the persistent complaint that the joint committee on vaccination and immunisation fails to give transparent advice. Its advice is subject to delay, and all the papers submitted to it are effectively invisible, because it is only the minutes of meetings that appear on its website several months after the meetings themselves are held. My constant plea is that we should have more transparency, as vaccines will become increasingly effective treatments.
	Another major issue raised in our debate is the take-up of drugs and the extent to which the NHS, through NICE, can access information about new drugs and their cost-effectiveness. My hon. Friend the Member for Windsor (Adam Afriyie) is right that there have been reductions in NICE funding, which has reduced the number of its appraisal committees from three to two at a time when their work load is increasing. For example, 29 new cancer drugs, a proportion of which will be fast-tracked, have to be submitted for appraisal. I shall not even consider the number of clinical guidelines that NICE should use, as it is important to focus on appraisals.
	We have urged Ministers to make good the reduction in NICE's resources, and I hope that the Minister will confirm that the Government will do so. The aim of the review of arms-length bodies associated with the Department of Health was not to cut bureaucracy but to try to focus resources on those that would be of the most value to people working on the front line in the NHS. The Health Committee emphasised the need for NICE to gain access to all the data accompanying licence applications to the Medicines and Healthcare products Regulatory Agency. As NICE will increasingly conduct appraisals alongside the MHRA, we may need to consider incentivising the acquisition of the appropriate data for NICE purposes while ensuring that companies are aware that they must produce data for MHRA licensing approval. Very often, those things happen in series, because the data required by each body are not the same. Companies are not sure whether NICE will make an appraisal, so any work that they undertake at an early stage may be costly and abortive. As the hon. Member for Falmouth and Camborne (Julia Goldsworthy) said, they do not know whether Ministers will refer a drug to NICE, or whether there will be a delay.
	We need greater independence in the process of choosing what should be referred to NICE and when. For the purposes of appraisal and issuing clinical guidelines, I accept that it is Ministers' responsibility to determine what should be referred to NICE. The structure for the appraisal of new drugs should be straightforward and independent. If they are likely to be a cost-effective response to existing NHS requirements to provide treatment, should that not be communicated to the NHS as soon as possible after independent assessment?
	Herceptin was mentioned by the hon. Member for Falmouth and Camborne and others, and it raises significant issues. The hon. Member for Newport, West spoke about the speed with which drugs are taken up. As it happens, Britain is not a country where drugs are taken up with alacrity. In October the Karolinska institute published a report, with the benefit of financial support from Roche, which I none the less think is true, showing that although Britain has the highest level of direct cancer research, we have one of the slowest rates of take-up of cancer drugs in Europe.

Andrew Lansley: Indeed. I have had the benefit of visiting the Christie hospital to see how translational research allows the whole range of cancer treatments to be provided in the same place, which is why, earlier this year, it was important to me to support the hospital in its argument that cancer surgery should not be transferred to another institution.
	I agree with the hon. Member for Bolton, South-East not least because in the new year Cancer Research UK will open its largest UK research facility at Addenbrookes hospital on the Cambridge biomedical campus. There will be 600 dedicated cancer researchers in my constituency, who will be operating alongside clinical teams. That will not be just translational research. As time goes on it will be the closest that Europe gets to the National Institutes of Health.
	I know that the Government are proposing to create a virtual national institute for health research, but at the Cambridge biomedical campus we have everything from the laboratory of molecular biology doing world-leading blue-skies research at molecular level through to teams doing translational work. Professor Bruce Ponder at Addenbrookes hospital will lead the oncology teams for the Cambridge University Hospitals NHS Trust while also being director of the new Cancer Research UK unit, combining responsibility for clinical work with responsibility for academic work.
	We will not debate the availability of clinical academics, but if we do not reverse the recent decline in the number of clinical academics following the recommendations of Mark Walport's committee, it will be difficult for us to sustain the benefits of research. We talk about drug research, but if we are to translate that into benefits in clinical practice, we will need clinical academics, and the more of them we have, the more likely we are to retain the drug companies' commitment to drug development in the UK.

Andrew Lansley: The hon. Gentleman keeps touching a raw nerve. I have corresponded with the Medical Research Council for some time on that matter. The working group that decided that the National Institute for Medical Research should be in central London rather than Cambridge because of the institute's international obligations was deluding itself. The work of the National Institute for Medical Research relates to the work of the institute of stem cell biology, which will be in Cambridge, and of the laboratory of molecular biology, which is in Cambridge, and I could on.
	Although Cambridge university was not that fussed—plenty of candidates want to be on the Cambridge biomedical campus—it would have been justified in objecting, and I certainly felt that a peculiarly blinkered view was taken on where medical research can be carried out. However, University college and University college London will provide a fine home, and I will have nothing said against them. [Interruption.] I had to get there eventually. I also want to echo the remarks by the right hon. Member for Rother Valley about the importance of safety.
	We must decide whether we believe in the process that NICE undertakes. We cannot believe in NICE and the independent evidence-based analysis of what is clinically effective and cost-effective, and then simply throw the results out of the window. The right hon. Member for Rother Valley and I share that view on infertility treatments, because if one asks NICE to produce guidelines, one cannot suddenly pop up and say, "Let's do something different."
	I acknowledge that Herceptin raises a completely different question. The matter does not rest with NICE, because the licence has not been applied for. That prompts the question on what basis is Herceptin being prescribed. I know the answer, because Cambridge university oncologists, who are convinced of its effectiveness, have written to me. Across the country, there are instances in which clinicians can prescribe drugs before licensing on the basis of their own judgment of emerging clinical evidence. However, that is a judgment by clinicians rather than by the Secretary of State or by a professional executive committee. Individual clinicians examine the data and take responsibility for such prescription.
	Before 2001, my predecessor, my hon. Friend the Member for Woodspring (Dr. Fox), suggested the creation of an exceptional medicines fund to help to accelerate the take-up of novel but potentially effective medicines in the NHS. I am not advocating that route—if we are devolving responsibility in the NHS, it is probably not appropriate—but it is one way to think about the problem. Even if we are devolving responsibility, we must examine, for example, the French system and understand more explicitly the circumstances in which such prescription should take place through the NHS. Perhaps we should involve NICE at an early stage in considering emerging evidence through clinical trials, even if the licensing process has not been completed. However, we should be aware that Herceptin, by its very nature, cannot be regarded as a precedent, and my party will not seek to use it in that way.
	The rest of the debate has concerned how we can support the industry while achieving effective self-regulation. Hon. Members disparaged the new code of practice promulgated through the ABPI, but we have to view these things with a bit of discretion. Frankly, if one sends a senior consultant who might be earning £150,000 to Kuala Lumpur, one can try to put him in a three-star hotel but I am not sure that he will stay there. Nobody has been expelled from the ABPI. However, I wonder whether we would conclude that the new standards and privileges arrangements brought into this House in recent years must be defective because nobody has yet been expelled. I am not sure if that is the right basis on which to judge such matters. [Interruption.] I am probably tempting the hon. Member for Newport, West again. Self-regulation is a better way to proceed. Let us ensure that we work with the industry. If we can see reasonable enhancements to the code of practice that are likely to have an impact, let us by all means propose them, but I heard no such substantive proposals today.
	We should think hard about how we support the pharmaceutical industry. We put an enormous burden on it as regards deciding where resources should go. An immense amount rests on its shoulders in terms of our futures. What would happen if those companies were to leave the UK? The disaster scenario would be GlaxoSmithKline deciding that it would be better off locating all its research and development activity in the United States. I do not suppose that it will happen—I fondly hope not, touching wood. That would have enormous consequences for this country, not only economically but in terms of our whole research base.
	I want to mention two areas: first, NHS research and development activity; and secondly, the role of the pharmaceutical price regulation scheme. The Government's document, "Best research for best health: A new National Health Research Strategy", confidently asserts:
	"A summary of responses, including the next steps, will be published by 30 November."
	As it is now some time after that, this is an excellent opportunity for the Minister to tell us what conclusions have been drawn from the consultation so far. Since 1991, when a director was first appointed, NHS research and development has grown in its scope and ambitions. I am pleased about that.
	The additional five areas of clinical research networks will be terribly important, but we wait to see what scale of resources will flow into them. The clinical research network on stroke requires there to be corresponding levels of NHS research funding, because in comparison with cancer a very small amount of money is spent on supporting stroke research, notwithstanding that stroke is the third largest killer in this country and the major cause of adult disability.
	Creating a network therefore needs the resources to support it. I hope that NHS research and development will take seriously the possibility of accepting more responsibility for the costs of clinical trials so that the NHS is in a position to undertake a higher proportion of such trials with patients.
	The Under-Secretary knows that one of the major factors that differentiate five-year survival rates in Britain from those in, for example, France is the extent to which patients take part in clinical trials. The National Cancer Research Network was established in 2001 and the number of patients in clinical trials doubled but we remain some way behind France. Of course, we have only one national clinical research network. Clinical trials with patients should be conducted in the NHS. However, the costs of clinical trials in this country have doubled and the regulation has increased dramatically. I cannot dissociate myself from some of the responsibility for that because, when we considered the Human Tissue Bill, we added to the regulatory burdens. After many discussions with the Department of Health, we managed to reduce them, but they remain. The clinical trials directive and the Mental Capacity Act 2005 also added to them.
	Many people who work on clinical trials and try to set them up tell horror stories about the number of bodies that they have to approach to set up a clinical trial. They include funding bodies, local hospital research approval bodies, distant research and ethics committees, and data protection committees. The list appears endless. Approaching all those bodies is not only expensive but can provide a major disincentive to clinicians, whose time is valuable to them and to the hospital when deciding whether to devote time to clinical trials. We need more patients in clinical trials.
	Let me consider the pharmaceutical price regulation scheme. I made it clear before the election that, if we had the chance to do so, we would consider the range of matters that support a strong biomedical research capacity in this country. That includes the NHS research and development strategy and I am pleased that the Government have published a document about that. However, we should also consider the cost of clinical trials, which I have just mentioned, and the action that we can take against animal rights terrorists. The further legislation that the Government have proposed is right but the industry will tell them that it is important to ensure that there is a drive behind enforcement.
	We should consider the economic framework through the PPRS. Although the report is excellent, the Committee described the PPRS and made a passing reference to reform in the context of marketing allowance, which, in the grand scale of things, is trivial, but did not tackle the central question of the purpose of the PPRS and whether it is a fit-for-purpose scheme. I do not suggest that it is not fit for purpose and no one in their right mind would suggest simply abandoning it and letting the industry charge what it liked for drugs that have intellectual property protection.
	However, many other countries have alternative mechanisms and we need to consider carefully what happens on a European-wide basis. Too many other countries buy in a centralised system but benchmark themselves on an international basis and increasingly choose to benchmark their prices below the average. If that continues, one or two major markets—the US and Japan—will overwhelmingly provide the profit to the pharmaceutical industry while Europe progressively reaches a point where it pays much less. That will not be a sustainable basis on which the industry can regard Europe as its second home for drug research and development. We must understand how to incentivise the conduct of research and development in this country in circumstances whereby we increasingly expose the industry to competition.
	I personally do not regard rate-of-return regulation as the right long-term solution, because it does not deliver genuine competitive pressures. The Government imposed a 7 per cent. cut, and no doubt that will deliver a reduction in the drugs bill. However, there is a lack of participation in the negotiations of the scheme by small drug companies and biotechnology companies, and this last review of the PPRS has exposed the way in which small companies, often those bringing just one product to the market, are severely disadvantaged. The big companies that negotiate the PPRS are able to change their prices between branded products; there is no real constraint in that regard. So if they have a competing product in a particular treatment area, they can respond through their price structures in ways that a small company with one product simply cannot.
	I still think that the PPRS provides an export disincentive. If companies are making major profits as a consequence of the exploitation of their drug in other markets, the price that they get from the NHS could be a disadvantage. There should be real incentives for exports, rather than disincentives. Although the research and development allowance went up, and although it can be an effective floor, I fear that it can also be a ceiling. Companies such as Pfizer have demonstrated the value of high levels of research and development activity in relation to their turnover, but our R and D allowance sets a benchmark and perhaps underplays the benefit of allowing companies to take a strategic option.
	The Office of Fair Trading is engaged in a review of these matters. I believe that the House, whether through the Select Committee or some other means, should examine the health and NHS purposes of the PPRS. I am an advocate of what the OFT does, and Members will recall that it quite rightly tries to drive towards competition outcomes. It needs to understand, however, what the health and NHS purposes of the PPRS are, in the course of its review.
	When the OFT considered the control of entry regulations in regard to pharmacies, it went away and thought about competition, and came up with a set of solutions. There was then a big row about the consequences because it had not taken fully into account the NHS purposes involved. Perhaps the answer is that we should derive all the competition benefits and, if the NHS wants other things, such as research, to happen, we might just have to pay more for that. Perhaps we should pay much more through the science and technology budgets to encourage companies to undertake their R and D here, and defray many more of the costs that they would otherwise meet.
	I am absolutely sure that, because the PPRS is not a statutory scheme—it is all voluntary—it is very difficult for us to get a handle on anything that happens in it. That is not necessarily because the Government and the industry are secretive; it is because there is no mechanism for the scheme to be examined. I am asking for a mechanism—perhaps operated through the Select Committee—by which we can examine the fitness for purpose of the PPRS. We should do this over the next year, not in three years' time, when any such examination would become confused with the question of the negotiations. It would be better to examine in theory what the PPRS is intended to do, before we arrive at the next PPRS negotiations.
	Having said all that, I believe that the Select Committee has done an excellent job that has resulted in real, positive benefits in terms of the reporting of adverse events and the promotion of a new code of practice throughout the industry. I hope that the report will also lead to the more open and responsible use of clinical trial data and to the establishment of a scientific community that is able to give us a much better idea of what works and what does not, because we depend dramatically on the output of the industry.

Liam Byrne: I am grateful for the opportunity to respond to this excellent debate. I, too, congratulate former and current members of the Select Committee on its report. I should like to add my own words of praise to those of the hon. Member for Southend, West (Mr. Amess) about the Committee's former Chairman, David Hinchliffe. Mr. Hinchliffe was very generous with his advice to me after I got this job, and I hope to be able to benefit from some of it this afternoon. I want to put on record my thanks and praise for him.
	My right hon. Friend the Member for Rother Valley (Mr. Barron) rightly began by saying that the House should be interested in an industry that develops new medicines from which we all benefit, and on which the national health service spends about £10 billion a year. Thousands of patients survive diseases such as cancer and coronary heart disease from which they would probably have died in the past.
	The industry is in no small part responsible for the extraordinary advances that the chief executive of the NHS was able to mention in his report, which was published yesterday. He was able to state, for instance, that over the past few years mortality rates for cardiovascular disease had fallen by more than 31 per cent., and that those for cancer had fallen by 14 per cent. I am sure that the whole House will wish to congratulate the staff of the NHS on the way in which they have harnessed our investment and reform to produce such remarkable results, with the help of Britain's pharmaceutical industry.
	My right hon. Friend presented an excellent summary of an excellent report, but before I respond to his points in detail, I want to deal with some of the points made by other Members. The hon. Member for Falmouth and Camborne (Julia Goldsworthy) is a direct beneficiary of some of the pioneering developments produced by the pharmaceutical industry. She referred to a number of issues involved in drug promotion, such as ghost-writing, regulation and Herceptin. I was pleased to learn of her concern about some of the future financing implications for the NHS. Fiscal rectitude does not commonly feature in Liberal Democrat speeches, but I welcome its emergence.
	The hon. Lady made an important point about inappropriate promotion of medicines. The MHRA can and does take action against the practice. She mentioned the inappropriate promotion of iPods. In that case the MHRA took action to stop the offer and require corrective statements to be made by the publication in which it appeared. Like a number of other Members, the hon. Lady mentioned the ABPI code. The code has been strengthened, but the key point is that it is underpinned by statutory controls, including criminal sanctions for breach of advertising regulations.
	My hon. Friend the Member for Newport, West (Paul Flynn) made an important contribution. His speech was well informed, well argued and backed by good evidence, as—I have come to learn—are all his speeches. He also spoke with great passion. He presented a powerful argument about the medicalisation of society. The Government made their position clear in the public health White Paper "Choosing Health: making healthier choices easier". In the White Paper, we emphasised the need for the NHS to become a health improvement and prevention service. We are tackling that in a number of ways, putting health and prevention at the centre of our national service frameworks but also giving primary care trusts real means with which to tackle health inequalities and improve health.
	My hon. Friend highlighted a dilemma. On the one hand, speed is needed in the licensing of drugs—my right hon. Friend the Member for Rother Valley, in particular, mentioned that—on the other hand, there is the need for safety. In that context my hon. Friend cited Vioxx, with which I shall deal later. There are real conflicts and dilemmas, and it was right for my hon. Friend to draw our attention to them.
	The hon. Member for Southend, West made a fascinating speech. I cannot wait to see those photographs: I look forward to the arrival of the December edition of The House Magazine. He mentioned issues relating to the ABPI code, with which I shall deal in a moment. He also referred to NICE funding, MHRA statutory controls and industry sponsorship. Let me deal first with the NICE budgets, which were also mentioned by the hon. Member for Windsor (Adam Afriyie).
	The Government created NICE for a reason, and recognise the value of its work. Its contribution to the health debate has been extraordinary over the past few years. The NHS and international medical science have benefited from its work. Like all arm's-length bodies, however, it has been asked to make savings in its back-office and accommodation costs. We have taken great care to protect the budget for its core work: the budget for 2004–05 is some £30 million. We are confident that NICE can deliver its challenging work programme within the existing envelope of those resources. It is, of course, for my right hon. Friend the Chancellor of the Exchequer to consider future spending in the spending review that will start next year.
	The issue of statutory powers is important. From 1 January 2005, the MHRA has required pharmaceutical companies to provide all the evidence. The powers have always been robust, but the new requirement to notify the MHRA without delay of all new information impacting on risks and benefits is, I think, very important and the Select Committee will welcome it. Failure to provide such information is a criminal offence to which the sanction of unlimited fines and imprisonment applies. It was right for the Select Committee to highlight that matter. The new measures introduced from the beginning of this year will go some way to addressing some of its concerns.
	The hon. Member for Southend, West mentioned Herceptin, as did the hon. Members for South Cambridgeshire (Mr. Lansley) and for Windsor. As we know, it has received considerable publicity from our constituents and also in the media. The drug is already licensed for women with advanced breast cancer, but not yet for those with early breast cancer. As the hon. Member for South Cambridgeshire said, a number of oncologists have pointed to its quite extraordinary potential.
	It is already possible for clinicians to prescribe a drug outside licensing indications. It is then down to individual clinicians to decide whether it is suitable to prescribe a specific drug after discussions with patients, taking into account the potential risks, not least those suggested by the patient's medical history. Primary care trusts then have to be involved, as they have to decide whether to support a clinician's decision and supply the drug at NHS expense. They will have to take a range of factors, including the circumstances of the individual patient, into account in taking those decisions.
	The position that my right hon. Friend the Secretary of State sketched out is really threefold. At the moment—pre-licence and pre-NICE—it is for individual clinicians to consider with patients whether Herceptin is an appropriate course of treatment. Secondly, PCTs should not rule out treatment in principle, but should consider individual circumstances in taking their decisions. Thirdly, PCTs should not refuse to fund Herceptin solely on the grounds of cost.
	My hon. Friend the Member for Bolton, South-East (Dr. Iddon) made a number of important points about parallel trade. It is, of course, a legitimate trade that is allowed under EU law, but there are controls on it. If safety concerns arise out of parallel trade, I am sure that the MHRA will be keen to know about them and will subsequently investigate. My hon. Friend trained as an organic chemist, so I know that he is well qualified to comment about the risks in the process of counterfeiting. I completely agree that it is a growing concern. The MHRA is working with regulators worldwide to combat what is an international problem. Evidence at the moment suggests that incidence in the UK is low, and tools are in place, carrying criminal sanctions, to deal with it.
	We certainly cannot afford to be complacent about that problem, particularly in the light of growing internet sales. I completely share the concern of my hon. Friend the Member for Bolton, South-East about the potential risk to the public. Public and patients are well advised to exercise great caution in purchasing medicines on the internet. My hon. Friend will know that the MHRA has had considerable success in taking action against illegal internet sales, which has been extensively covered in the media this week. It remains a difficult area to police and the MHRA continues to find new ways of impacting on illegal sales. I am sure that, as the hon. Member for Broxbourne (Mr. Walker) suggested, that matter will benefit from our further attention on the Floor of the House.
	The hon. Member for Wyre Forest (Dr. Taylor) talked about many matters, particularly highlighting the need to align industry research priorities with NHS public health aims. As we are spending about £10 billion a year, that is not an unreasonable expectation. The Government found the Select Committee's conclusion extremely helpful. One of the ways in which we are taking its recommendations forward is through the UK's clinical research collaboration. As a first step, we have asked that a futures forum be held, to bring together many of the key stakeholders to advise Ministers on the future priorities for innovation in health care. The forum will be held in 2006 and it will be informed by the results of an ongoing strategic analysis of current research, funded by partner organisations. The pharmaceutical industry will be included, and the report will be available next spring.
	The hon. Member for Wyre Forest spoke about Vioxx with some import. Vioxx is an important part of the debate, particularly if we contrast the associated issues with those associated with Herceptin. There is a central dilemma and we are very grateful to the Committee for highlighting it. My questions, and those of other Ministers, are essentially the same as the Committee's. Why did pre-licence clinical trials not illustrate some of the problems? Were the trials long enough? Why did spontaneous adverse reporting not show up some of the problems post-introduction? As my hon. Friend the Member for Newport, West asked, what lessons can be learned to mitigate the possibility of such problems occurring again?
	Like Herceptin, Vioxx was seen as an incredibly important drug. It had the potential to provide an important level of pain relief and it did not have the side-effects associated with many existing drugs. The pre-clinical trials did not show up all the various problems and although there were differences with the placebo group, they were on a pretty shallow curve. Indeed, it can take up to 18 months for some of the side-effects to become apparent. That said, patients were obviously anxious for this new and potentially very valuable drug to come on to the market as quickly as possible. Adverse reporting was not going to help because many of the associated side-effects can be attributed to underlying patient conditions, such as heart disease and diabetes.
	Since then, an extremely important change has occurred. From the end of October this year, the licensing requirements for new drugs include the requirement for a risk-management plan, which must be agreed with licensing authorities. It can stipulate a range of requirements to monitor the effects and side-effects of new drugs, so for the first time, regulators have a degree of latitude in specifying, for example, the long-term clinical trials necessary in the new drugs field. That was an important issue for the Committee to highlight.
	The hon. Member for Wyre Forest also discussed the promotion of new medicines. The ABPI code now restricts promotion on the launch of new products, but to underpin that code the MHRA is vetting the advertising material for new drugs. However, we will monitor the new measures and if they do not deliver the change that the Committee and the Government are looking for, we will have to look again at the current controls.
	Expert advisory groups is another important issue that was raised. The Committee on Safety of Medicines will have expert advisory groups—some 14 of them—and they are in the process of being appointed. As Members know, the Government adhere very closely to the Nolan principles, so the appointments being made—from some 400 to 500 candidates and from every area of expertise, including lay members—will take a little longer. In the meantime, however, the committee can call on the expertise of an external panel of experts in order to cover specialist areas.
	The hon. Member for Broxbourne, who has worked at the coal face of many of the issues that we have discussed today, raised the question of SSRIs, as did my hon. Friend the Member for Newport, West. The UK has gone further and has acted much faster in reviewing SSRIs than any regulator worldwide. The CSM's expert working group's report, which was published a year ago almost to the day, has been recognised as the most thorough review of a class of medicines ever undertaken. It resulted in new advice—backed by an unprecedented release of summaries of clinical trial data—which was published alongside NICE guidelines. The MHRA continues to monitor the safety of selective serotonin reuptake inhibitors, and this week issued new advice on the use of Seroxat in pregnancy. I do not think that that is a record of complacency.
	I turn now to the points of substance contained in the Select Committee report, which my right hon. Friend the Member for Rother Valley spelled out with great eloquence. If I may, I shall take a slight detour through the vexed question of how many conclusions and recommendations the Government have accepted.
	From what I understand, the Select Committee report grouped a number of recommendations into one overall recommendation. The Government responded to all the recommendations, and to the sub-recommendations that they contained. Of the 32 recommendations, 26 were accepted in full or in part. I know that the Government response took some time, but the Committee took 10 months to write the report, and it was felt that the response needed proper consideration. After all, as my right hon. Friend the Member for Rother Valley said, this is the first such report for many years.
	My right hon. Friend the Member for Rother Valley raised various points, and I shall try to deal with each in turn. First, he asked about MHRA governance arrangements, an issue also highlighted by the hon. Member for Southend, West. When it was reviewed by the National Audit Office, the MHRA—which was then known as the Medicines Control Agency—was found to be a major contributor to public health in the UK. That was a welcome finding, as was the assessment that it was a world leader in some respects, such as in the field of drug safety.
	The agency is tackling directly some of the issues raised in the NAO report, and the Government response strongly welcomes the Select Committee's suggestion that there should be a further review once current reforms have bedded in. In addition, and as is to be expected, Ministers continue to monitor the MHRA's performance. The agency has been strengthened by the adoption of many new internal controls of its own, which will ensure that the agency remains independent and its staff free of conflict.
	Nevertheless, I welcome the suggestion from my right hon. Friend the Member for Rother Valley that the House should monitor the agency's progress closely. I am sure that his proposal that the House and the Select Committee should provide input in respect of the review's terms of reference will be of great interest to my right hon. Friend the Secretary of State.
	As part of the ongoing reform process, the MHRA recently revised its medicines advisory committee structure. The Commission on Human Medicines came into being on 1 November. It is not a direct result of the Select Committee report, but it does deal with some of the issues raised in that report. For example, each advisory committee now contains two lay members, to ensure that wider judgments are made about risk benefit as well as about medical and scientific matters. Importantly, the new structure allows the patient voice to be heard in the regulatory process, and the rules on the interests of committee members have also been strengthened. As a result, the new committee's chairman and members will not be allowed to hold financial interests in the pharmaceutical industry.
	My right hon. Friend the Member for Rother Valley also raised issues to do with promotion and industry information, both pre and post-licensing, and six or seven points are relevant in that context. First, since the Government's response was published, much progress has been made on ensuring high standards in the promotion of medicine. For instance, initial advertising is now vetted before publication.
	Secondly, the agency has delivered on its commitment to agree a memorandum of understanding with the prescription industry's self-regulatory body, which was published last month. Thirdly, and as the hon. Member for South Cambridgeshire pointed out, the ABPI code has now been strengthened.
	Fourthly, a great deal of progress has been made in improving the quality of patient information, about which the hon. Member for Wyre Forest spoke most cogently. I have not had the benefit of visiting Australia to see how matters are handled there, but if I behave myself that opportunity may be afforded me at some time in the future.
	The issue of promoting information to patients is important, especially in a world in which, as my hon. Friend the Member for Bolton, South-East (Dr. Iddon) mentioned, people are beginning to buy products on the internet. The new requirement for user testing of information in patient information leaflets came into force in the UK in July, ahead of the time frame in European law. That will deliver potentially the most powerful tool to ensure that the needs of patients are properly met. In the same month, the expert group of the Committee on Safety of Medicines published its report, "Always read the leaflet", with new guidance on user testing, risk communication and, importantly, the usability of patient information leaflets.
	The fifth measure was on the safety monitoring of medicines, to which many hon. Members referred. As my right hon. Friend the Member for Rother Valley mentioned, patients and members of the public have been able to report suspected adverse drug reactions through the yellow card scheme since January 2005. Since then, around 750 yellow card reports from patients and members of the public have been received. Since the Committee reported, the UK-wide patient reporting pilot was launched in October, developed on the basis of considerable engagement with stakeholders, and supported by a major promotional campaign.
	The sixth area, which many hon. Members on both sides of the House will welcome, is the registration of clinical trials. The Health Committee argued in favour of the registration of all clinical trials and the publication of the results of trials. The Government largely accept that argument. We fully support the case for transparency and accountability, and we are working nationally and internationally to get the principles applied in practice. A number of important developments have taken place in the past year, and it is now clear that the movement towards registering trials and providing much better public access to research evidence about safety and effectiveness is unstoppable. Much of the momentum comes from a shared aim of the Government and the industry to build public confidence. International pharmaceutical industry associations have made public commitments, which have been strengthened by the understandings in the UK. At the same time, the World Health Organisation is working on standards for trial registration and international agreement on systems to give easy access to information, and the European Medicines Agency is about to launch a public database called EuroPharm. We very much welcome all those developments.
	To go further, however, the Government strongly support more openness and transparency in the regulation of medicines. The MHRA is making good progress in that field, as we highlighted in our response. A communication strategy is now in place, which considers how we raise the profile of the agency and increase the understanding of medicines-related issues among the general public. In our published regulatory information, all newly licensed programmes will be accompanied by a UK public assessment report, which will be posted on the MHRA website. The agency also regularly publishes summaries of clinical trial data to support key communications on drug safety, along with all details of adverse drug reactions.
	Several Members, such as the hon. Member for Falmouth and Camborne and my right hon. Friend the Member for Rother Valley, mentioned the report in The Observer a week or two ago about the alleged case of research misconduct involving a comparative study of two drugs for the treatment of osteoporosis. The MHRA is investigating that at the request of the chief medical officer. The aim of the investigation is to establish whether there has been an abuse of the regulations governing clinical trials, but it will also seek to establish whether legislation requiring companies to submit immediately to the MHRA any new information that might affect the risk-benefit balance of the product has been breached. The Government view that as a very serious matter—false research can lead to the wrong treatment being given.
	For academics who might be involved, who are not part of a profession, criminal sanctions are not yet available. At the moment, we rely on employers to take action. That is why we warmly welcome Universities UK's initiative in setting up a UK panel for research integrity in health and biomedical science. One of its functions will be to help research employers, including universities, the NHS and industry, to take effective action against allegations of scientific misconduct.
	My right hon. Friend the Member for Rother Valley, in his concluding remarks, highlighted the need for speed in introducing drugs to market. That is something that is being addressed in part through the ministerial industry steering group, which brings together leaders from the pharmaceutical industry and Ministers to consider issues that might impact on the industry. One of those issues is how regulation can be adopted to accelerate the pace of introduction of new drugs to market, including what kind of controls are needed and how can we gather safety data to avoid scares such as the withdrawal of Vioxx. We have to keep in mind the balance between public safety and the difference that new drugs can make.
	The issue of NICE is part and parcel of that. I have dealt with the question of its funding and it is now out to public consultation on fast-track assessment on single therapies. Those assessments will sit alongside full appraisals. NICE is now prioritising its work plan to ensure that new needs are met.
	I welcome much of the Committee's report, but I also welcome much of what the hon. Member for South Cambridgeshire said. He was right, in particular, to say that connecting for health has extraordinary power to help. I know that I am not supposed to say this in the new mood of consensus that has broken out on the Floor of the House, but connecting for health is not free. Its future rests on investment—the kind of investment that is precluded by policies such as the patient's passport. After the events of the past two days, I look forward to hearing about its future.
	We have had a useful, lively debate this afternoon. The pharmaceutical industry brings enormous benefits to this country, to patients and the NHS and to the economy.

Andrew Selous: I am especially grateful to Mr. Speaker for granting me this Adjournment debate, which deals with serious issues of public safety. I hope that the Minister will realise how serious these matters are, and that in his response he will be as positive as possible about how to deal with them.
	The problem of multiple road traffic offences, which involves vehicles registered at false or incorrect addresses, has been brought to my attention by a number of my constituents. Vehicles that they have never owned and about which they know nothing have been registered at their addresses, with the result that the police have been in contact with them on many occasions.
	I want to pay tribute to Bedfordshire police for their persistent action to try to deal with this problem, and specifically to PC Sean Quinn and PC Graham Dunn, who have worked tirelessly on behalf of the people of Bedfordshire in that regard.
	The problem, in essence, is the police's complete inability to prevent and successfully prosecute repeated road traffic offences of an extremely serious nature. Let me give some examples.
	In the case of excessive speed, I have recent documented examples, with photographic evidence, of drivers doing 98 mph in a 50 mph limit, 117 mph in a 50 mph limit at night, 73 mph in a 30 mph at night, and 82 mph in a 30 mph limit in the middle of Dunstable, a major town in my constituency. The highest recorded speed that has come to my attention was of a vehicle doing 119 mph in a 50 mph limit, on 4 September this year on the A505 between Leighton Buzzard, Dunstable and Houghton Regis in my constituency. As I shall explain shortly, such vehicles have been doing those sorts of speeds in those conditions time and again.
	There is a problem not just with speed, but with vehicles jumping red lights, in some cases up to six seconds late. We know that one vehicle has done that on nine separate occasions, but the police are powerless to do anything about it. The reason that the police are powerless is, as I said, that vehicles are incorrectly registered to false addresses, or cloned, whereby a vehicle of a similar description to that which the perpetrator wants to register to a false address is registered to a law-abiding person's address. Farmers are often coerced into having their property used as a false postal address. One property in Chelmsford—25 Duke street—is notorious among not only Bedfordshire police but Essex police. I understand that it is no more than a drop-off postal address at which many vehicles are registered, apparently legally, but the police have no ability to contact the owners or do anything about the perpetrators of such offences.
	As well as excessive speeds and going over red lights, there have been examples of extremely dangerous driving, such as people driving with their hands over their face at 64 mph at night, people taking their hands completely off the wheel even at night in a 30 mph zone, a child in the front seat on an adult's lap with no seat belt, and many offensive gestures made by drivers of vehicles at cameras. In the village of Kensworth in my constituency, which has a speed camera, a photograph was taken of a driver with one hand on the wheel while giving a thumbs up gesture out of the window to the camera with the other. All three other adults in the car are grinning at the camera. That shows that people who behave in such a way know that they can break the law, are flaunting their law-breaking and are taunting the police, who, they know, are powerless to act.
	The Minister will agree that the danger to the public from the examples that I have given is huge. How would he like people driving in that manner to come close to the vehicle in which he was travelling with his family?
	The problem is significant, and the incidents are not isolated. As at 7 April this year, the police have evidence of 1,004 such offences in south Bedfordshire alone. Of those, 466 were current and due to have fines paid of just under £28,000, and 538 offences were lost under the six-month rule, so the police had no ability to recoup more than £32,000 of fines that will not be paid. Therefore, there is also a public expenditure implication, and I am sure that the Minister would want all fines that have been properly levied to be paid and to come in to the police.
	The powers that are needed to do something about this problem are as follows. The police need to be given the ability to seize a vehicle that is incorrectly registered and involved in multiple offences. The police should then have the power to retain that vehicle until the owner or offender is correctly identified and, if necessary, to dispose of the vehicle by suitable means, not least to pay off any fines levied on it. The police also need a further power of entry to land and/or garages—not dwellings, as people obviously do not keep cars in their houses—to seize such vehicles.
	As I said, these are repeat offences. Moments before the debate, I was told that one van still on the road in South Bedfordshire has just clocked up its 73rd offence and a motorcycle has clocked up 61 offences. When I say "multiple offences", that is the order that I am talking about.
	Bedfordshire police have done their homework on this issue and visited the Home Office on 15 April. I understand that it was suggested to the police that section 59 of the Police Reform Act 2002 should be sufficient for them to be able to address the problem. Bedfordshire police then contacted another five police forces to discover whether they were in the same position of not being able to apply section 59 in practice on the ground. Thames Valley police replied:
	"To have power to seize vehicles showing multiple offences, if granted, would indeed be a useful tool in increasing road safety, if the safeguards required did not blunt its effectiveness . . . I can say that we rarely use the Police Reform Act because of the frustrations put upon us by the control room."
	Suffolk police replied that
	"it could also be extended to cover vehicles owned by foreign nationals. We have a serious problem with transient workers in the food processing industry. They use a single base address to register their vehicle and then quickly move on."
	Greater Manchester police said that they had
	"asked our force solicitor re anti-social behaviour and serving a notice on the owner/driver of multiple offenders (concerning seizure). The Solicitor's response has deemed the act inappropriate in this case."
	Cambridgeshire police replied:
	"I would see seizure of vehicles could be promoted as a major contribution to road safety, in getting the cars out of circulation, even though temporarily."
	And Essex police replied:
	"I am not aware of any forces using the Police Reform Act for repeat offenders of camera activations, and there does not appear to be any other legislation that may assist."
	I understand that it has also been suggested that section 43(c) of the Vehicle Excise and Registration Act 1994, which was put in place by the Serious and Organised Crime and Police Act 2005, has been suggested as a means of dealing with the problem, but I am again reliably informed by the police that that is not the case because that provision deals purely with driving without a valid driving licence and driving without insurance. Most of these vehicles are driven by people with licences and most are insured. So that legislation would not do the job that is required.
	I tabled a parliamentary question on this issue recently to ask the Secretary of State to make a statement on the effect of the registration of false vehicle licence addresses on the ability of the police to combat multiple road traffic offences. The Under-Secretary of State for the Home Department, the hon. Member for Wythenshawe and Sale, East (Paul Goggins), replied:
	"An accurate register is important for identification purposes, so that the police can take effective action against the perpetrators."
	The problem is that we do not have an accurate register. He continued:
	"we have strengthened the likelihood of accuracy by the introduction of continuous registration and by creating a new offence of using a vehicle that is incorrectly registered."—[Official Report, 5 December 2005; Vol. 440, c. 968W.]
	That power does not give the police the powers that they need to do the job.
	In a letter to me dated 21 November, the Driver and Vehicle Licensing Agency stated:
	"It is essential therefore that information about vehicle keepers on the register is both accurate and up-to-date but we are very much reliant on the public and the motor trade to provide this information."
	It said that the information is used to
	"assist with road safety, law enforcement and the collection of vehicle excise duty."
	I hope that I have outlined the scale of the problem and how serious it is. It is not a party political matter. What can we do about it? The Minister will know that the Road Safety Bill is about to arrive in this House. I have looked carefully at the Bill with Bedfordshire police and I suggest that it should be possible to amend clause 15—the clause deals with speeding, but we need to look at red-light issues and at dangerous driving—on the power to seize, retain and dispose of vehicles. Could we insert in clause 36 a requirement to prove one's address when a vehicle is registered? I know that the Government have looked at this and decided not to go down that route, but given the scale of the problem in my area alone, will the Minister agree to take the issue back, perhaps to a joint working party between the Home Office and the Department for Transport, and look at it again to see whether utility and council tax bills, or documents of that nature, should be required?
	Above all, this is a crime prevention measure. I would argue that, if we get these measures on the statute book, we would rarely need to use them because the deterrent would be such that the word would go out that the police had the necessary powers. People would comply and the problem would disappear. I look forward with eager anticipation to the Under-Secretary's reply.